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Posted by on Sep 23, 2013 in Wisconsin | 0 comments

Wisconsin will see many regional exchange plans

Wisconsin’s Federally Facilitated Exchange

What website will I use to apply for subsidies, compare plan options, and enroll in coverage?

On November 16, 2012, Governor Scott Walker notified federal officials that Wisconsin would default to a federally-facilitated health insurance exchange. Consumers in Wisconsin can use the federal HealthCare.gov website to shop for health insurance come October 1.

Will coverage and premiums be the same statewide?

On September 19, 2013, the Wisconsin Office of the Commissioner of Insurance released a chart showing the counties in which companies will be participating for both the individual and SHOP exchange markets. While no carrier is offering coverage statewide, all counties have at least one individual health insurance carrier option; out of 72 counties, 59 will have multiple carrier options for individuals. A few counties will not have any SHOP options. You can view the OCI’s chart for more information.

The state of Wisconsin has been divided into 16 geographic rating areas, shown below, which are used to help determine health insurance premiums. Insurance companies may charge different premiums in each of the regions.

WI_Rating_Areas_Map

Which companies will offer coverage through the new online health insurance marketplace?

On August 6, 2013, the Wisconsin Office of the Commissioner of Insurance, announced that the state had completed its filing reviews.

“This is only the first step in the process,” explained Insurance Commissioner Ted Nickel. “Insurers wishing to participate in the federal exchange will need to complete an additional federal review process and sign a contract to participate on the exchange.”

Here are the 13 individual companies that have been approved by the OCI to offer coverage though the individual exchange and the nine companies approved by the OCI to offer coverage through the SHOP exchange:

Insurers Seeking to Participate in the Federal Exchange

INDIVIDUAL MARKET SMALL EMPLOYER GROUP MARKET
Common Ground Healthcare Cooperative Common Ground Healthcare Cooperative
Compcare Health Services Insurance Corp. Group Health Cooperative
Dean Health Plan, Inc. Gundersen Health Plan, Inc.
Group Health Cooperative Health Tradition Health Plan
Gundersen Health Plan, Inc. Medica Insurance Company
Health Tradition Health Plan MercyCare HMO
Medica Health Plans of Wisconsin MercyCare Insurance Company
MercyCare HMO, Inc. Security Health Plan of Wisconsin, Inc.
Molina Healthcare of Wisconsin, Inc. Arise (WPS Health Plan, Inc.)
Physicians Plus Insurance Corporation
Security Health Plan of Wisconsin, Inc.
Unity Health Plans Insurance Corp.
Arise (WPS Health Plan, Inc.)

Common Ground Health Cooperative was created as a result of the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program, which fostered the creation of new consumer-governed, private, nonprofit health insurance issuers. In February 2012, Common Ground Healthcare Cooperative (CGHC) was awarded a loan from the U.S. Department of Health and Human Services to launch the new health insurance cooperative. Common Ground Healthcare Cooperative announced March 11, 2013 it received their Certificate of Authority from the Wisconsin Office of the Commissioner of Insurance.

The new non-profit will offer individual exchange plans at the gold, silver, bronze, and catastrophic metal levels through a partnership with Aurora Health Care (the state’s largest healthcare system) and Trilogy Health Networks to offer provider networks. The CGHC service area includes 19 counties throughout Eastern Wisconsin.

CGHC_Service_Area

Compcare Health Services Insurance Corporation, dba Anthem Blue Cross and Blue Shield will offer individual HMO plans.

Dean Health Plan, Inc. will offer individual plans; the individual HMO Prevea360 Health Plan in Northeastern Wisconsin will be offered at the gold, silver, bronze, and catastrophic metal levels and DHP individual Focus EPO in Southern Wisconsin will be offered at the bronze metal level.

Group Health Cooperative of South Central Wisconsin, a non-profit, member-owned cooperative with a thirty-seven year history will be offering individual HMO plans and small group HMO, PPO, and POS plans, including: platinum preferred, gold plated, silver standard, bronze basic and catastrophic care (for qualifying individuals).

Gundersen Health Plan, Inc. will be offering individual POS plans and small group HMO and POS plans in Eastern Wisconsin. Here is a look at the current service area:

Gundersen_Service Area

Health Traditional Health Plan will have individual HMO plans available at the gold, silver, bronze, and catastrophic metal levels and small group plans will be offered at the platinum, gold, silver, and bronze metal levels. Current plans are available in 12 Western Wisconsin counties.

Medica Health Plans of Wisconsin will be offering their individual Applause plans and Medica Insurance Company will be offering small group Medica Choice Passport plans  at the gold, silver, and bronze metal levels.

MercyCare Plans, aka MercyCare Insurance Company, Inc., a wholly owned subsidiary of Mercy Health System Corporation, offers coverage in Southern Wisconsin; you can view the service area below. MercyCare Insurance Company will offer small group PPO products and MercyCare HMO, Inc. will offer individual and small group MercyCare HMO products.

Mercy_Care_Service_Area

Molina Healthcare of Wisconsin, Inc. is offering Molina Marketplace plans in multiple states where the company offers Medicaid health plans. According to Molina’s website, “[Their] plans allow [their] Medicaid members to stay with their providers as they transition between Medicaid and the Marketplace.” In Wisconsin, Molina has four silver plan options and a gold plan available.

Physicians Plus Insurance Corporation will offer individual HMO and POS products at the platinum, gold, silver, and bronze metal levels. The corporation currently offers coverage in Madison and South-Central Wisconsin.

Security Health Plans of Wisconsin, Inc. will offer individual and small group exchange plans in a 32-county area. Here is a look at the company’s current service area:

Security Health Plan_Serive_Area

Unity Health Plans Insurance Corp., a wholly-owned subsidiary of University Health Care, Inc. an affiliate of University of Wisconsin Hospital and Clinics and the University of Wisconsin Medical Foundation will offer individual products. Coverage is currently available in Southern Wisconsin.

Unity_Service_Area

Arise Health Plan, a wholly owned subsidiary of Wisconsin Physicians Service Insurance Corporation, will be offering individual plans at the platinum, gold, silver, bronze, and catastrophic metal levels and small group plans at the platinum, gold, silver, and bronze metal levels.

Arise_WPS_Service Area

New information is being released every day. Follow this blog to receive updates as new information is released in Wisconsin.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

Learn more at www.strenuus.com.

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